Endovascular thrombectomy is a cornerstone of ischaemic stroke managament. Time from stroke to intervention has been clearly linked to functional outcome (1) and is a key metric to which much attention is devoted. But what about the duration of the procedure itself? Earlier data has suggested that length of procedure may affect functional outcomes after stroke (2). This study by Alawieh et al recently published in the Journal of the American College of Cardiology evaluated data from 1359 patients who underwent thrombectomy, either with a stent retriever or direct aspiration. The authors revealed that procedures with a duration in excess of 30 minutes resulted in a reduced likelihood of a favourable outcome (as assessed with modified Rankin score). They further noticed a plateau in outcome improvement in thrombectomies lasting longer than 60 minutes. There was also a demonstrably higher rate of haemorrhagic complications in the longer-lasting procedures. This indicates that procedure time has direct impact on patient-important outcomes, or as the authors themselves conclude…..

“Longer ET procedures lead to lower rates of functional independence and higher rates of sICH (Ed.: post-procedural symptomatic haemorrhage) and complications. Exceeding 60 min or 3 attempts should trigger careful assessment of futility and risks of continuing the procedure.”

1. Time to Endovascular Treatment and Outcome in Acute Ischemic Stroke. MR CLEAN Registry Results. Mulder et al. Circulation. 2018;138:232–24.
2. The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. Spiotta et al. J Neurointerv Surg 2014;6:511–16. doi:10.1136/neurintsurg-2013-010726